Patient education and provider decision support to control blood pressure in primary care: A cluster randomized trial

Bosworth, Hayden B.; Olsen, Maren K.; Dudley, Tara K.; Orr, Melinda; Goldstein, Mary K.; Datta, Santanu K.; McCant, Felicia; Gentry, Pam; Simel, David L.; Oddone, Eugene Z.

doi:10.1016/j.ahj.2008.11.003

Cited by 90 publications

(129 citation statements)

References 18 publications

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“…For sensitivity analysis, we transformed MET minutes per week using a square root transformation, and we also compared the change in MET minutes from baseline to 24 months between arms, using a Wilcoxon rank-sum test. For the secondary binary outcome, BP control, we used a generalized estimating equation (GEE) model, 23 which accounts for clustering of patients within clinics and repeated measures within patients. We used a logit link and unstructured covariance.…”

Section: Methodsmentioning

confidence: 99%

Nurse-Led Behavioral Management of Diabetes and Hypertension in Community Practices: A Randomized Trial

et al. 2015

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BACKGROUND: Several trials have demonstrated the efficacy of nurse telephone case management for diabetes (DM) and hypertension (HTN) in academic or vertically integrated systems. Little is known about the real-world potency of these interventions. OBJECTIVE: To assess the effectiveness of nurse behavioral management of DM and HTN in community practices among patients with both diseases. DESIGN: The study was designed as a patient-level randomized controlled trial. PARTICIPANTS: Participants included adult patients with both type 2 DM and HTN who were receiving care at one of nine community fee-for-service practices. Subjects were required to have inadequately controlled DM (hemoglobin A1c [A1c]≥ 7.5 %) but could have well-controlled HTN. INTERVENTIONS: All patients received a call from a nurse experienced in DM and HTN management once every two months over a period of two years, for a total of 12 calls. Intervention patients received tailored DM-and HTN-focused behavioral content; control patients received non-tailored, non-interactive information regarding health issues unrelated to DM and HTN (e.g., skin cancer prevention). MAIN OUTCOMES AND MEASURES: Systolic blood pressure (SBP) and A1c were co-primary outcomes, measured at 6, 12, and 24 months; 24 months was the primary time point. RESULTS: Three hundred seventy-seven subjects were enrolled; 193 were randomized to intervention, 184 to control. Subjects were 55 % female and 50 % white; the mean baseline A1c was 9.1 % (SD=1 %) and mean SBP was 142 mmHg (SD=20). Eighty-two percent of scheduled interviews were conducted; 69 % of intervention patients and 70 % of control patients reached the 24-month time point. Expressing model estimated differences as (intervention -control), at 24 months, intervention patients had similar A1c [diff=0.1 %, 95 % CI (−0.3, 0.5), p=0.51] and SBP [diff=−0.9 mmH g, 95% CI (−5.4, 3.5), p=0.68] values compared to control patients. Likewise, DBP (diff=0.4 mmHg, p=0.76), weight (diff=0.3 kg, p=0.80), and physical activity levels (diff=153 MET-min/week, p=0.41) were similar between control and intervention patients. Results were also similar at the 6-and 12-month time points. CONCLUSIONS: In nine community fee-for-service practices, telephonic nurse case management did not lead to improvement in A1c or SBP. Gains seen in telephonic behavioral self-management interventions in optimal settings may not translate to the wider range of primary care settings.

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Section: Methodsmentioning

confidence: 99%

Nurse-Led Behavioral Management of Diabetes and Hypertension in Community Practices: A Randomized Trial

et al. 2015

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“…However, he stresses that individual motivations to engage in the implementation of a change is less important than the level with which the members of the organization collectively value a change project. For their part, Shaw et al [23] identify perception of effectiveness and cost effectiveness while Bosworth et al [25] add a fit with the organizations' mission, goals and values and a perceived increase in job satisfaction as other factors that are associated with change valence.…”

Section: Orc Determinants: Change Valence and Informational Assessmentmentioning

confidence: 99%

Facilitators, Barriers and Management Competencies Associated with Schools' Readiness to Implement New Accountable Practices

Lauzon¹

2017

ujm

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Enrolling in the wake of an administrative and educational reform, the implementation of a new "results-based" management is shaking the schools' traditional values and practices, so the culture that characterizes them. In light of the results of three descriptive studies conducted with different groups of stakeholders concerned by this change, this text examines some of the main facilitators and barriers associated with schools' readiness to implement new regulation and evaluation practices. It also shed some light on competencies needed by school principals and their assistants to manage such a cultural change.

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“…[6][7][8] In brief, the trial evaluated 3 telephone-based interventions through a 4-group design: (1) nurse-administered, physician-directed medication management intervention using a validated clinical decision support system; (2) nurse-administered, behavioral management intervention; (3) combined behavioral management and medication management intervention; and (4) usual care. Interventions were activated based on home BP measurements collected via telemonitoring.…”

Section: Study Design and Study Populationmentioning

confidence: 99%

“…The behavioral management intervention consisted of 11 tailored health behavior modules focused on improving HSM, including the following 7 : hypertension knowledge including medication side effects, medication memory, resources to improve healthcare access, and patient-provider relationship. Patients were also provided evidence-based recommendations regarding salt intake, weight, stress reduction, smoking cessation, and alcohol use.…”

Section: Behavioral Management Interventionmentioning

confidence: 99%

Do the Benefits of Participation in a Hypertension Self-Management Trial Persist After Patients Resume Usual Care?

Maciejewski

Bosworth

Olsen

et al. 2014

Circ: Cardiovascular Quality and Outcomes

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Interventions that combine self-management (SM) support and individualized medical management theoretically represent a potentially sustainable intervention for patients with hypertension if they retain and apply skills learned in such interventions after returning to usual care. The longer-term clinical and economic benefits of SM interventions remain largely untested because only 5 prior studies tracked clinical outcomes after completion of SM trials in patients with hypertension. Results from the United Kingdom Prospective Diabetes Study (UKPDS) 1 found that the clinical benefits of tight blood pressure (BP) control were not sustained ≤10 years after trial completion. Editorial see p 205The Steno-2 2 follow-up study of patients with diabetes mellitus and microalbuminuria and 3 follow-up studies of pharmacist interventions for patients with hypertension suggested that SM interventions had long-lasting effects.3-5 These long-term clinical benefits may translate into reductions in healthcare utilization and costs, but no prior trial has reported long-term economic outcomes once patients return to usual care.The purpose of this article is to examine clinical and economic outcomes 18 months after completion of an 18-month Background-Hypertension self-management has been shown to improve systolic blood pressure (BP) control, but longerterm economic and clinical impacts are unknown. The purpose of this article is to examine clinical and economic outcomes 18 months after completion of a hypertension self-management trial. Methods and Results-This study is a follow-up analysis of an 18-month, 4-arm, hypertension self-management trial of 591 veterans with hypertension who were randomized to usual care or 1 of 3 interventions. Clinic-derived systolic blood pressure obtained before, during, and after the trial were estimated using linear mixed models. Inpatient admissions, outpatient expenditures, and total expenditures were estimated using generalized estimating equations. The 3 telephonebased interventions were nurse-administered health behavior promotion, provider-administered medication adjustments based on hypertension treatment guidelines, or a combination of both. Intervention calls were triggered by home BP values transmitted via telemonitoring devices. Clinical and economic outcomes were examined 12 months before, 18 months during, and 18 months after trial completion. Compared with usual care, patients randomized to the combined arm had greater improvement in proportion of BP control during and after the 18-month trial and estimated proportion of BP control improved 18 months after trial completion for patients in the behavioral and medication management arms. Among the patients with inadequate baseline BP control, estimated mean systolic BP was significantly lower in the combined arm as compared with usual care during and after the 18-month trial. Utilization and expenditure trends were similar for patients in all 4 arms. Conclusions-Behavioral and medication management can generate systolic BP improvements ...

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Patient education and provider decision support to control blood pressure in primary care: A cluster randomized trial

Cited by 90 publications

References 18 publications

Nurse-Led Behavioral Management of Diabetes and Hypertension in Community Practices: A Randomized Trial

Nurse-Led Behavioral Management of Diabetes and Hypertension in Community Practices: A Randomized Trial

Facilitators, Barriers and Management Competencies Associated with Schools' Readiness to Implement New Accountable Practices

Do the Benefits of Participation in a Hypertension Self-Management Trial Persist After Patients Resume Usual Care?

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